1,007 research outputs found
Physiotherapists provide considerable services to children with ASD and indicate needs for professional development and clinical guidelines: an observational study.
Measuring motor function of children with mild/moderate intellectual impairment using the HiMAT/ Revised HiMAT compared to BOT2: a pilot validation study
Can mid-semester examinations predict outcomes of final examinations when mature adult learners participate in different modes of on-line learning?
Primary caregivers' evaluation of a burns rehabilitation programme at the Red Cross Childrens' Hospital
Thesis (MPhil)--Stellenbosch University, 2005.ENGLISH ABSTRACT: A bum injury is an injury for life, causing scarring on a physical, emotional and psychological
level. For these individuals, rehabilitation is a vital aspect of regaining their lives. The bums
unit at the Red Cross Children's Hospital aims to provide a comprehensive health care service to
all children who have suffered from a bum injury. The service is enveloped by an
interdisciplinary team approach to management. The burns team perceives the rehabilitation
programme to be an effective one, but this has never been evaluated. The researcher has the
perception that the primary caregivers are the people who could evaluate the bums unit at the
Red Cross Children's Hospital.
Hence the aim of this study was to determine how primary caregivers evaluated the rehabilitation
of a child at the burns unit of the Red Cross Children's Hospital.
The design of the study was of a retrospective, descriptive and analytical nature. The study
population consisted of all primary caregivers of patients who have been managed in the burns
unit at the Red Cross Children's Hospital, from the period of 1 June 2001 to 30 July 2003. A
sample size of 30 primary caregivers, who suited the inclusion and exclusion criteria, were
randomly chosen. They were all interviewed using questionnaires that were compiled by the
researcher. Quantitative and qualitative data was collected during the interviews.
Results on the evaluation of aspects such as management in hospital, caregiver involvement,
discharge planning and rehabilitation outcome, showed that primary caregivers found most
aspects to be satisfactory at the burns unit of Red Cross Children's Hospital. The scores on the
level of satisfaction of the above aspects were between 86% and 100% for management, between
94%-97% for discharge planning, 97% for caregiver involvement, and 75%-100% for
rehabilitation outcome. Factors that were reported to be unsatisfactory were pain management,
the child's psychological outcome and service and fit of pressure garments.
Recommendations regarding pain management and reintegration of the child into the community
were made to team members of the unit. The urgent need for a full time psychologist was
advocated to the hospital management. These recommendations were based on the findings of
this study.AFRIKAANSE OPSOMMING: 'n Brandbesering is 'n lewenslange besering wat liggaamlike, emosionele en sielkundige letsels
laat. Vir individue met sodanige beserings is rehabilitasie hoogs belangrik vir die herwinning
van hulle lewens. Die brandwondeenheid van die Rooikruis Kinderhospitaal het ten doelom 'n
omvattende gesondheidsorgdiens aan alle kinders wat 'n brandbesering opgedoen het, te bied.
Die diens word deur 'n interdissiplinêre spanbenadering tot bestuur omsluit. Die brandspan
beskou die rehabilitasieprogram as effektief, maar dit is nooit voorheen geëvalueer nie. Die
navorser is van mening dat primêre versorgers ons van sienings rakende die bestuur van
brandpasiënte kan voorsien.
Die doelwit van hierdie studie was om te bepaal hoe primêre versorgers die rehabilitasie van 'n
kind by die brandwondeenheid van die Rooikruis Kinderhospitaal geëvalueer het.
Die studie se ontwerp was retrospektief, beskrywend en analities van aard. Die studiebevolking
het bestaan uit alle primêre versorgers van pasiënte wat vir die tydperk van 1 Junie 2001 tot 30
Julie 2003 in die brandwondeenheid van die Rooikruis Kinderhospitaal behandel is. 'n
Steekproefgrootte van 30 primêre versorgers, wat aan die insluitings en uitsluitingkriteria
voldoen het, is ewekansig gekies. Onderhoude is met almal gevoer deur middel van vraelyste
wat deur die navorser opgestel is. Kwantitatiewe en kwalitatiewe data is tydens die onderhoude
versamel.
In die lig van die aspekte van bestuur in die hospitaal, die betrokkenheid van versorgers,
ontslagbeplanning en rehabilitasie-uitkoms is die slotsom bereik dat primêre versorgers met die
meeste aspekte van die brandwondeenheid van die Rooikruis Kinderhospitaal tevrede was. Die
tellings vir die vlak van tevredenheid van die bogenoemde aspekte was tussen 86% en 100% vir
bestuur, 97% vir die betrokkenheid van versorgers, tussen 94% en 97% vir ontslagbeplanning en
tussen 75% en 100% vir rehabilitasie-uitkoms. Faktore wat as onbevredigend uitgewys is, was
pynbeheer, die kind se sielkundige uitkoms asook die diens en pas van drukkIeding.
Op grond van die bespreking en resultate van hierdie studie, was aanbevelings by die eenheid se
spanlede asook die hospitaalbestuur gedoen
Scope And Outcomes Of A Trauma Quality Improvement Program At Royal Prince Alfred Hospital, Australia 2006-2016
Background Injury and trauma remain important causes of morbidity and mortality globally. Trauma systems have been established to facilitate optimal management of injured patients, including timely access to specialist trauma centres in those who are severely injured. Trauma quality improvement programs have emerged over the past decade to evaluate and improve quality of care delivered by trauma systems and trauma centres. Despite this, there remains little evidence to demonstrate that these quality improvement programs actually improve patient outcomes or whether they are cost-effective. In 2006, a trauma quality improvement program was initiated at Royal Prince Alfred Hospital, Australia. This consisted primarily of the implementation of trauma team activation and resuscitation protocols, and the evaluation of care through the use of clinical indicators (key performance indicators) and measurement of post discharge health status. Objectives This thesis describes a quality improvement program at Royal Prince Alfred Hospital that involved monitoring of all major clinical services involved in the acute care of trauma at this hospital, and evaluates this program with respect to in-patient mortality for severe injury, cost effectiveness and long term outcomes. Methods The studies were conducted at Royal Prince Alfred Hospital (RPA) in New South Wales Australia. The thesis is presented in four main sections. The first section (chapters 1 to 4) provides an outline of the thesis and summarises the current literature on trauma quality improvement programs. Preliminary papers describe the historical context of the trauma service at this institution and discuss the conceptual framework for trauma patient data collection. The second section (chapters 5 to 9) provides background information regarding contemporaneous trends in injury presentations to Emergency Departments and major trauma activity and mortality across NSW. The third section (chapters 10 to 13) details and evaluates the impact of the trauma quality improvement program on long-term major trauma mortality trends at this hospital using time series analysis and its cost effectiveness in a subset of road trauma patients. It also investigates health status outcomes in trauma patients at three and six months after hospital discharge - a project initiated as part of the quality improvement program. Results Injury is one of the leading causes of presentations to Emergency Departments across NSW and the critically injured make up around 1% of total injury presentations. Major trauma in-hospital mortality across NSW has remained stable at around 16% between 2003 and 2014. The trauma quality improvement program at RPA was associated with a significant reduction in major trauma mortality from 16% to 10% after 2007. The incremental cost effectiveness was estimated to be $7600 per year of life saved in the subset of road trauma patients. Analyses of health outcomes after discharge revealed increasing injury severity and upper limb injuries were the only predictors of reduced employment status after injury, and lower limb injuries were associated with reduced physical health status compared to those without lower limb injuries at both 3 and 6 months post discharge. Around 37% of patients reported signs of psychological distress and this did not change significantly during the study interval. Conclusions This thesis has published important new information regarding the clinical and cost-effectiveness of trauma quality improvement programs. It contains the first published studies evaluating these interventions using formal time series and health economics analysis and one of few reporting the intervention in the context of existing injury and trauma management systems in New South Wales Australia
Patterns of injury and violence in Yaoundé Cameroon: an analysis of hospital data.
BackgroundInjuries are quickly becoming a leading cause of death globally, disproportionately affecting sub-Saharan Africa, where reports on the epidemiology of injuries are extremely limited. Reports on the patterns and frequency of injuries are available from Cameroon are also scarce. This study explores the patterns of trauma seen at the emergency ward of the busiest trauma center in Cameroon's capital city.Materials and methodsAdministrative records from January 1, 2007, through December 31, 2007, were retrospectively reviewed; information on age, gender, mechanism of injury, and outcome was abstracted for all trauma patients presenting to the emergency ward. Univariate analysis was performed to assess patterns of injuries in terms of mechanism, date, age, and gender. Bivariate analysis was used to explore potential relationships between demographic variables and mechanism of injury.ResultsA total of 6,234 injured people were seen at the Central Hospital of Yaoundé's emergency ward during the year 2007. Males comprised 71% of those injured, and the mean age of injured patients was 29 years (SD = 14.9). Nearly 60% of the injuries were due to road traffic accidents, 46% of which involved a pedestrian. Intentional injuries were the second most common mechanism of injury (22.5%), 55% of which involved unarmed assault. Patients injured in falls were more likely to be admitted to the hospital (p < 0.001), whereas patients suffering intentional injuries and bites were less likely to be hospitalized (p < 0.001). Males were significantly more likely to be admitted than females (p < 0.001)DiscussionPatterns in terms of age, gender, and mechanism of injury are similar to reports from other countries from the same geographic region, but the magnitude of cases reported is high for a single institution in an African city the size of Yaoundé. As the burden of disease is predicted to increase dramatically in sub-Saharan Africa, immediate efforts in prevention and treatment in Cameroon are strongly warranted
An investigation into the effects of commencing haemodialysis in the critically ill
<b>Introduction:</b>
We have aimed to describe haemodynamic changes when haemodialysis is instituted in the critically ill. 3
hypotheses are tested: 1)The initial session is associated with cardiovascular instability, 2)The initial session is
associated with more cardiovascular instability compared to subsequent sessions, and 3)Looking at unstable
sessions alone, there will be a greater proportion of potentially harmful changes in the initial sessions compared
to subsequent ones.
<b>Methods:</b>
Data was collected for 209 patients, identifying 1605 dialysis sessions. Analysis was performed on hourly
records, classifying sessions as stable/unstable by a cutoff of >+/-20% change in baseline physiology
(HR/MAP). Data from 3 hours prior, and 4 hours after dialysis was included, and average and minimum values
derived. 3 time comparisons were made (pre-HD:during, during HD:post, pre-HD:post). Initial sessions were
analysed separately from subsequent sessions to derive 2 groups. If a session was identified as being unstable,
then the nature of instability was examined by recording whether changes crossed defined physiological ranges.
The changes seen in unstable sessions could be described as to their effects: being harmful/potentially harmful,
or beneficial/potentially beneficial.
<b>Results:</b>
Discarding incomplete data, 181 initial and 1382 subsequent sessions were analysed. A session was deemed to
be stable if there was no significant change (>+/-20%) in the time-averaged or minimum MAP/HR across time
comparisons. By this definition 85/181 initial sessions were unstable (47%, 95% CI SEM 39.8-54.2). Therefore
Hypothesis 1 is accepted. This compares to 44% of subsequent sessions (95% CI 41.1-46.3). Comparing these
proportions and their respective CI gives a 95% CI for the standard error of the difference of -4% to 10%.
Therefore Hypothesis 2 is rejected. In initial sessions there were 92/1020 harmful changes. This gives a
proportion of 9.0% (95% CI SEM 7.4-10.9). In the subsequent sessions there were 712/7248 harmful changes.
This gives a proportion of 9.8% (95% CI SEM 9.1-10.5). Comparing the two unpaired proportions gives a
difference of -0.08% with a 95% CI of the SE of the difference of -2.5 to +1.2. Hypothesis 3 is rejected. Fisher’s
exact test gives a result of p=0.68, reinforcing the lack of significant variance.
<b>Conclusions:</b>
Our results reject the claims that using haemodialysis is an inherently unstable choice of therapy. Although
proportionally more of the initial sessions are classed as unstable, the majority of MAP and HR changes are
beneficial in nature
Epidemiology and outcomes of patients admitted to hospital with a burn injury in Scotland
Burn injuries are a significant cause of both morbidity and mortality throughout the world. The prevalence of burn injuries and the demographics of those affected vary across the globe, especially between developed and developing countries. However, the risk of burn injury remains consistently higher in individuals from a background of socioeconomic deprivation.
With advances in medical care in recent decades, the chances of survival following major burn injury have increased significantly. With individuals now surviving much more substantial injuries, there is an increasing appreciation of the long-lasting pathophysiological and psychological consequences that can occur following such an injury. Common sequelae include chronic pain, pruritus, depression or anxiety, post-traumatic stress disorder and an increase in the risk of cardiovascular disease, cancer and various infections.
However, the exact aetiology and risk factors associated with being more likely to suffer such detrimental consequences are incompletely understood. Additionally, the deterioration in health conditions after injury may be explained by both the risk factors common to sustaining a burn injury and the physiological impact of the burn injury itself.
The studies detailed in this thesis aim to explore the epidemiology of, and mortality from, burn injuries in Scotland; investigate the effectiveness of using neuropathic agents to manage the symptoms of burn-related pruritus; describe the prevalence and predictors of pruritus after burn injury; explore the use of a protocolised treatment regimen for pruritic symptoms; and use national administrative databases to explore the long-term consequences following survival of a burn injury including the use of drugs to manage pain and mental health conditions and the likelihood of death in the following years.
This thesis includes a systematic review and meta-analysis to explore the effectiveness of drugs commonly used to treat neuropathic pain in the management of burn-related pruritus. Although there is a paucity of evidence that exists, gabapentinoids appear to be effective at reducing pruritus severity scores by 2.96 (95% CI 1.20, 4.73) on a zero to ten scale when compared to antihistamine or placebo.
Using prospective data collected as part of a quality improvement project in a tertiary referral burn ward, this study explored the factors associated with pruritus severity in patients with a burn injury. Multivariable linear regression analysis demonstrated that increasing size of burn, as measured by surface area, flame burns, a history of smoking and history of alcohol use disorder were all associated with an increase in pruritus severity. Although low serum vitamin D levels were prevalent among this cohort of patients, with 83% of patients having serum vitamin D levels <50nmol/L, the presence or severity of this apparent deficiency did not correlate with the severity of pruritic symptoms. The use of a protocolised approach to pruritus management with various antihistamine drugs and gabapentin in the presence of neuropathic features was consistently effective at reducing pruritus severity scores.
The remaining chapters of this thesis used large linked national datasets to describe the epidemiology and outcomes for patients that suffered a burn injury requiring hospital admission in Scotland. The results show that males are more likely to sustain a burn injury than females, accounting for 63% of admissions. Children were more likely to sustain a scald injury (63% of injuries) with flame burns being relatively rare in children (6%) but much more prevalent in adults (29%). Patients from areas of socioeconomic deprivation made up a greater proportion of both the adult and paediatric cohort. Children from an ethnic minority background were found to be at a higher proportion than would be expected for the general population in Scotland, a pattern not seen in the adult cohort.
Of the adult population, 2.73% died within 30 days of their burn injury. Multivariable cox proportional hazards regression analysis demonstrated that, in keeping with multiple previous studies, increasing age (HR 1.08), increasing size of burn (HR 1.12) and the presence of smoke inhalation injury (HR 14.54) were all associated with an increased mortality. Additionally, a pre-existing history of depression or neurological disorder were also independently associated with mortality (HR 13.65 and 6.48 respectively).
Pre-injury use of drugs such as opioids was significantly higher in this burn-injured cohort compared to the general population in Scotland (25.8% vs 18% respectively). Following burn injury, the use of opioids increased from 25.8% to 38.5% of patients. This increase was evident in prescriptions for both strong and weak opioids. An increase was also seen in the number of patients receiving recurrent (three or more) prescriptions. Factors associated with an increase in opioid use after injury included female gender, previous opioid use, increasing age, socioeconomic deprivation and increasing comorbidity burden.
Compared with the general population of Scotland, the pre-injury use of various drugs for mental health conditions were all higher in this burn-injured cohort including antidepressants (15.2% vs 26.6% respectively), antipsychotics (1.5% vs 6%) and anxiolytics (6.8% vs 16.3%). This study did not demonstrate a higher proportion of patients using these drugs post-injury, however, following a burn, there was a higher burden of drug utilisation, with more patients receiving multiple drugs for mental health conditions, and a higher frequency of prescriptions. Factors associated with this increase in the use of these drugs were found to be similar to that seen with opioids, namely female gender, history of alcohol excess, depression and previous opioid use. Gabapentinoid use was also higher in the burn cohort pre-injury (6%) compared to the general population (4.1%), with their use increasing further after burn injury to 9.5%.
Lastly, for patients that survived to 30 days following burn injury, one in twenty died in the follow-up period to a maximum of four years. Multivariable Cox proportional hazards analysis demonstrated that increasing age and increasing comorbidity burden were associated with increased hazards ratios (1.06 and 3.51 respectively). As were the presence of airway burn or smoke inhalation (HR 2.8) and the pre-injury use of anxiolytic drugs (2.13).
The work presented in this thesis systematically reviews the existing evidence for neuropathic agents in managing burn-related pruritus; assesses a protocolised approach to managing such pruritus; outlines the epidemiology of burns in Scotland; describes the mortality from burns and the associated risk factors; describes the burden of pain and mental health conditions using drug prescription data as a surrogate measure of these conditions; and describes the factors associated with death in the years after surviving a burn injury.
This information may be used by clinicians to inform decisions regarding management of burn-related pruritus. This work also provides a deeper understanding of the complex interplay between mental health conditions, drug use, comorbidity burden and socioeconomic deprivation that often affect those that suffer a burn injury. It also highlights some of the important outcomes following survival of a burn injury with an increased risk of chronic opioid use, especially among those with certain characteristics.
Future research should focus on exploring the influence of the pathological effects of the burn injury compared to the high prevalence of pre-existing conditions that can similarly contribute to morbidity and mortality
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